EP0381588B2 - Intervertebral flexible stabilizer - Google Patents

Intervertebral flexible stabilizer Download PDF

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Publication number
EP0381588B2
EP0381588B2 EP19900400291 EP90400291A EP0381588B2 EP 0381588 B2 EP0381588 B2 EP 0381588B2 EP 19900400291 EP19900400291 EP 19900400291 EP 90400291 A EP90400291 A EP 90400291A EP 0381588 B2 EP0381588 B2 EP 0381588B2
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EP
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Prior art keywords
ligament
intervertebral
ligaments
fitted
characterised
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP19900400291
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German (de)
French (fr)
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EP0381588B1 (en )
EP0381588A1 (en )
Inventor
Francis Henri Bréard
Henry Graf
Original Assignee
Francis Henri Bréard
Henry Graf
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002Longitudinal elements, e.g. rods
    • A61B17/7019Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7022Tethers, i.e. longitudinal elements capable of transmitting tension only, e.g. straps, sutures or cables
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842Flexible wires, bands or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06Measuring instruments not otherwise provided for
    • A61B2090/061Measuring instruments not otherwise provided for for measuring dimensions, e.g. length

Description

La présente invention se rapporte à un stabilisateur inter-vertébral destiné à être mis en place entre au moins deux vertèbres pour corriger des défauts du rachis. The present invention relates to an intervertebral stabilizer to be set up between at least two vertebrae to correct defects of the spine.

Les stabilisateurs inter-vertébraux utilisés à l'heure actuelle pour réduire les effets souvent douloureux des maladies du rachis, comme les scolioses, les hernies discales ou les instabilités lombaires, sont des plaquettes ou des tiges métalliques que l'on fixe aux vertèbres ou à leurs apophyses épineuses, le long du tronçon affecté du rachis, ce qui a pour inconvénient d'immobiliser complètement les vertèbres et donc de limiter ou même d'interdire tout mouvement de flexion ou de torsion du tronc du patient. The inter-vertebral stabilizers used at present to reduce the often painful effects of spine diseases, such as scoliosis, herniated discs or lumbar instabilities are platelets or metal rods that are fixed to the vertebrae or their spinous processes along the affected section of the spine, which has the drawback of completely immobilize the vertebrae and thus limit or even prevent any bending movement or twisting of the patient's trunk.

La présente invention se propose de remédier à cet inconvénient et, pour ce faire, elle a pour objet un stabilisateur inter-vertébral d'un type nouveau, qui se caractérise en ce qu'il comprend un ou plusieurs ligament(s) souple(s), à flexibilité omnidirectionnelle, muni(s) de moyens d'accrochage respectivement associé(s) à deux organes de retenue implantables chacun dans une vertèbre respective. The present invention proposes to overcome this drawback and, to do this, it provides a intervertebral stabilizer of a new type, which is characterized in that it comprises one or more ligament (s) Soft (s ), omnidirectional flexibility, provided (s) respectively associated fastening means (s) two implantable retaining members each in a respective vertebra.

Avantageusement, le ou l'un au moins des ligaments souples présente la forme générale d'une boucle fermée ou en variante est muni d'un anneau ou d'une boucle fermée à chacune de ses extrémités, les extrémités de chaque ligament constituant alors lesdits moyens d'accrochage, par lesquels celui-ci peut être accroché à des organes de retenue, chacun de ceux-ci, de préférence constitués par une vis, présentera avantageusement une tête libre pour l'accrochage d'une extrémité respective du ligament correspondant. Advantageously, the at least one flexible ligaments has the general shape of a closed loop or alternatively is provided with a ring or a loop closed at each of its ends, the ends of each ligament then constituting said hooking means by which it can be hooked to the retaining members, each one thereof, preferably constituted by a screw, advantageously has a free head for gripping a respective end of the corresponding ligament.

On dispose ainsi d'un stabilisateur inter-vertébral souple ou semi-élastique qui, suivant son mode d'implantation, d'un côté seulement ou des deux côtés des apophyses épineuses des vertèbres touchées, sur la face avant ou la face arrière de ces dernières, avec un seul ligament ou plusieurs montés en chaíne ou mutuellement croisés, permet de compenser toutes sortes de défauts ou déformations du rachis en agissant en compression. This provides a flexible intervertebral stabilizer or semi-elastic which, following its implantation mode, one side only or both sides of the spinous processes of the vertebrae affected, on the front face or the rear face of these last, with a single ligament or more mounted chain or mutually crossed, can compensate for all sorts of defects or deformities of the spine acting in compression. Simultanément, et grâce à la flexibilité omnidirectionnelle du ou des ligaments utilisés, le stabilisateur selon l'invention autorise un mouvement suffisant de distraction et/ou de rotation des vertèbres pour ne pas gêner le patient dans ses mouvements de flexion ou de torsion du tronc. Simultaneously, thanks to the flexibility of omnidirectional or ligaments used, the stabilizer according to the invention allows sufficient movement of distraction and / or rotation of the vertebrae so as not to hinder the patient in its flexion or torsion of the trunk.

A côté de cet avantage principal, le stabilisateur inter-vertébral selon l'invention est d'un montage extrêmement simple, puisqu'il suffit d'engager les extrémités de chaque ligament en forme de boucles ou d'anneaux respectivement autour, par exemple, de deux vis préalablement implantées dans les vertèbres. In addition to this main advantage, the inter-vertebral stabilizer according to the invention is an extremely simple assembly, since it is sufficient to engage the ends of each ligament in the form of loops or rings around respectively, for example, two screws previously implanted in the vertebrae.

Pour éviter tout glissement du ligament après sa mise en place, autour des organes de retenue, tels que des vis, il est en outre avantageusement prévu, sur chaque organe de retenue, une coiffe amovible surdimensionnée radialement par rapport à sa tête et s'adaptant sur celle-ci. To prevent slippage of the ligament after its installation, around the retaining members, such as screws, it is also advantageously provided on each retainer, a removable cap oversized radially in relation to its head and fitting on this one. On obtiendra le même effet en munissant en variante la tête de chaque organe de retenue d'une saillie latérale d'arrêt du ligament. We will obtain the same effect by providing alternatively the head of each retaining member of a side stop projection of the ligament.

Plusieurs modes de réalisation du stabilisateur inter-vertébral selon l'invention, vont maintenant être décrits plus en détails, mais sans caractère limitatif, en référence aux dessins annexés sur lesquels : Several embodiments of the inter-vertebral stabilizer according to the invention will now be described in more detail, but without limitation, with reference to the accompanying drawings wherein:

  • la figure 1 représente une vue latérale en coupe partielle du stabilisateur inter-vertébral selon le premier mode de réalisation de l'invention ; 1 shows a side view in partial section of the inter-vertebral stabilizer according to the first embodiment of the invention;
  • les figures 2a et 2b illustrent des variantes de réalisation du stabilisateur de la figure 2 ; Figures 2a and 2b illustrate alternative embodiments of the stabilizer of Figure 2;
  • la figure 2 est une vue de face d'un stabilisateur inter-vertébral conforme au deuxième mode de réalisation de l'invention ; Figure 2 is a front view of an inter-vertebral stabilizer according to the second embodiment of the invention;
  • les figures 3a, 3b et 3c illustrent l'un des organes de retenue du ligament du stabilisateur de la figure 1 ; Figures 3a, 3b and 3c illustrate one of the retaining members of the ligament of the stabilizer of Figure 1;
  • les figures 4a et 4b montrent respectivement, en vue longitudinale en coupe et en vue de face, l'un des organes de retenue du stabilisateur de la figure 2 ; Figures 4a and 4b respectively show in longitudinal sectional view and front view of one of the retaining members of the stabilizer of Figure 2;

La figure 1 représente deux vertèbres voisines V1, V2 du rachis d'un patient, réunies par un stabilisateur inter-vertébral selon l'invention, qui se compose d'un ligament souple 1 en forme de boucle fermée et de deux vis 2, 3 implantées chacune dans une vertèbre respective, pour retenir entre elles le ligament 1, celui-ci étant simplement engagé autour des têtes élargies cylindriques 4 des vis, émergeant des vertèbres. Figure 1 shows two adjacent vertebrae V1, V2 of the spine of a patient, connected by an inter-vertebral stabilizer according to the invention, which consists of a flexible ligament 1 in the closed loop-shaped and two screws 2, 3 each located in a respective vertebra, for holding therebetween the ligament 1, the latter being simply engaged around the cylindrical enlarged heads of the screws 4, emerging from the vertebrae. Le ligament 1 est un ligament artificiel en "Dacron" (marque déposée) ou tout autre matière plastique souple, à flexibilité omnidirectionnelle. The ligament 1 is an artificial ligament in "Dacron" (Trade Mark) or other flexible plastic material, omnidirectional flexibility.

Comme le montre mieux les vues en coupe longitudinale et de face des figures 3b et 3c, chaque vis comporte, dans sa tête 4, un perçage axial borgne 5, de section hexagonale, dans lequel on peut engager une clé à six pans pour implanter la vis dans la vertèbre correspondante. As best shown in longitudinal sectional views and front views of Figures 3b and 3c, each screw has in its head 4, a blind axial bore 5, a hexagonal section, in which may engage a hex key for implanting the screw in the corresponding vertebra.

Après la mise en place du ligament 1 autour des vis ainsi implantées, on ferme le perçage 5 de chacune d'elles à l'aide d'une coiffe ou bouchon plat circulaire 6, représenté seul sur la figure 3a, ce bouchon, de diamètre nettement supérieur à celui de la tête 4 de la vis, venant se visser par un picot central 7 à bout fileté, dans un taraudage 8 débouchant dans le fond du perçage 5. Pour réaliser ce vissage, on utilisera une clé spéciale coopérant avec deux encoches 9,9a formées sur le pourtour de chaque bouchon. After the establishment of the ligament 1 around the thus implanted screws, closing the hole 5 of each of them with a cap or flat circular cap 6, shown only in Figure 3a, this cap diameter significantly higher than that of the head 4 of the screw, which is screwed by a central stud 7 threaded end into a threaded bore 8 opening into the bottom of the bore 5. to achieve this screwing, a special key will be used cooperating with two notches 9,9a formed on the periphery of each plug. En variante, chaque coiffe ou bouchon 6 peut être muni d'un évidement central hexagonal et être vissé dans la tête 4 de la vis correspondante à l'aide d'une clé à six pans s'engageant dans cet évidement hexagonal. Alternatively, each cap or stopper 6 may be provided with a hexagonal central hole and be screwed into the head 4 of the corresponding screw with an Allen wrench engaging the hexagonal recess. En saillant radialement tout autour des têtes respectives 4 des vis, les deux bouchons 6 empêchent tout glissement du ligament 1 hors de ces dernières, comme l'illustre la figure 1. In projecting radially around the respective heads of the screws 4, the two plugs 6 prevents any sliding of the ligament 1 out of the latter, as illustrated in Figure 1.

Les bouchons 6 présentent un intérêt particulier lorsque le stabilisateur inter-vertébral selon l'invention comprend plusieurs ligaments souples supplémentaires, tels que représentés en 1a et 1b sur la figure 1, montés en chaíne avec le premier 1, sur les vertèbres précédant et suivant les deux représentées V 1 ,V 2 , à l'aide d'un même nombre de vis supplémentaires de retenue. The stoppers 6 are of particular interest when the inter-vertebral stabilizer according to the invention comprises several additional flexible ligaments, as shown in 1a and 1b in Figure 1, assembled chain with the first one, on the vertebrae before and after the both represented V 1, V 2, using the same number of additional retaining screw.

Dans le cas illustré par la figure 2, où l'on n'aura à interposer qu'un ligament 1 en forme de boucle fermée entre seulement deux vertèbres successives V 1 ,V 2 , on peut en variante doter la tête 4 de chaque vis 2 ou 3 d'une saillie latérale 10 de hauteur convenable comme représenté de profil et de face sur les figures 4a et 4b. In the case illustrated by Figure 2, where it will interposing a ligament 1 in the form of a closed loop between only two successive vertebrae V 1, V 2, the head 4 can alternatively acquire each screw 2 or 3 of a side projection 10 of suitable height, as shown in profile and face in figures 4a and 4b. Dans ce cas, il faudra tout d'abord implanter les deux vis 2,3 en orientant leurs saillies 10 l'une en face de l'autre, pour pouvoir ensuite glisser sans entrave le ligament 1 autour de leur tête 4, après quoi on fera subir aux vis un demi-tour supplémentaire pour placer les saillies 10 dans leur position de retenue du ligament, représentée sur la figure 2. In this case, it will first locate the two screws 2.3 by directing their projections 10 facing one another, in order to then slide unimpeded ligament 1 around their heads 4, whereupon will undergo to screw a further half turn to place the projections 10 in their ligament retaining position, shown in Figure 2.

Le stabilisateur inter-vertébral selon l'invention permet, selon son positionnement, de combattre de nombreuses maladies douloureuses, affectant le rachis. The inter-vertebral stabilizer according to the invention, according to its positioning, combat many painful disease affecting the spine. Celui des figures 1 et 2 est mis en place sur la face arrière des vertèbres V 1 ,V 2 et d'un côté seulement de leurs apophyses épineuses A 1 ,A 2 , mais on peut aussi suivant le type de maladie à traiter, utiliser deux stabilisateurs conformes à l'invention, montés de part et d'autre des apophyses A 1 ,A 2 ou en croix entre les deux vertèbres V 1 ,V 2 , sur la face avant ou la face arrière de celles-ci. That of Figures 1 and 2 is placed on the rear face of the vertebrae V 1, V 2 and only one side of their spinous processes A 1, A 2, but can also according to the type of disease to be treated, use two stabilizers conforming to the invention, mounted on either side of the processes A 1, A 2 or cross between the two vertebrae V 1, V 2, on the front face or the rear face thereof.

Selon une variante de réalisation du stabilisateur de la figure 2, illustrée par la figure 2a, le ligament 1c présente la forme d'un simple segment 40 dont les deux extrémités sont chacune reliées à un anneau métallique 41 ou 42, par lequel le ligament peut être accroché à la tête 4 d'une vis de retenue respective 2 ou 3. According to a variant embodiment of the stabilizer of Figure 2, illustrated in Figure 2a, 1c ligament has the shape of a single segment 40 whose two ends are each connected to a metal ring 41 or 42, by which the ligament can be attached to the head 4 of a respective retaining screw 2 or 3.

Selon une autre variante illustrée par la figure 2b, le ligament 1d, en forme de boucle fermée, est introduit à l'intérieur de lui-même pour former une première boucle d'extrémité 43 s'engageant autour d'un organe de retenue implantée dans une vertèbre respective V 1 . According to another variant illustrated in figure 2b, 1d ligament in the shape of a closed loop, is introduced inside itself to form a first end loop 43 engaging around an implanted retainer in a respective vertebra V 1. A hauteur de sa seconde extrémité, le ligament 1d est passé autour de l'organe de retenue implantée dans la vertèbre inférieure V 2 , puis reintroduit dans lui-même pour, par l'intermédiaire d'un goujon d'arrêt 44, former une seconde boucle d'extrémité 45. Il va de soi également qu'un montage en chaíne de plusieurs ligaments, comme sur la figure 1, est possible avec les modes de réalisation des figures 2a et 2b, à l'aide de vis de retenue préalablement implantées. A height of its second end 1d ligament is passed around the holding member located in the lower vertebra V2, then reintroduced into itself to, by means of a detent 44, form a second end loop 45. It also goes without saying that a mounting chain more ligaments, as in Figure 1, is possible with the embodiments of figures 2a and 2b, using setscrew previously implanted.

Les vis 2,3 peuvent quant à elles être remplacées par tout autre organe de retenue implantable dans une vertèbre et muni d'une tête libre pour l'accrochage d'une extrémité du ligament. The screws 2,3 can for their part be replaced by any other retaining member implantable in a vertebra and having an open head for hooking one end of the ligament.

Il convient encore de préciser que les vis ou autres organes de retenue 2,3, leurs bouchons 6 seront de préférence réalisées en un alliage métallique biocompatible. It should also be noted that the screws or retainers 2.3, their caps 6 are preferably made of a biocompatible metal alloy.

Claims (4)

  1. An intervertebral stabiliser consisting of a set of one or more ligaments fitted with a means of attachment corresponding respectively to two anchor pins (2, 3) each of which may be implanted in its respective vertebra (V1, V2). The whole is intended to he placed in position between at least two consecutive vertebrae, the ligament or ligaments being souple (1, 1a, 1b, 1c, 1d) in all directions and is characterised by the fact that: :
    at least one of the souple ligaments (1, 1a, 1b) has the general shape of a closed loop whose two ends form the above-mentioned means of attachment,
    at least one of the souple ligaments (1c, 1d) is fitted at each end with a band (41, 42) or a closed loop (43, 45) forming the above-mentioned means of attachment.
  2. An intervertebral stabiliser as described in Claim 1 in which each of the ligaments, fitted with a means of attachment, is used with two anchor pins characterised by the fact that each such anchor (2, 3) possesses a free head (4) to which can be attached the appropriate end of the corresponding ligament (1, 1a, 1b, 1c, 1d).
  3. An intervertebral stabiliser as described in Claim 2 and characterised by the fact that each of the anchor components (2, 3) includes a removable cap (6) of greater diametric radius than the above-mentioned head (4) and intended to be fitted over the latter.
  4. An intervertebral stabiliser as described in Claim 2 and characterised by the fact that the head of each anchor component (2, 3) is fitted with a lateral ridge (10) intended to keep the ligament in place.
EP19900400291 1989-02-03 1990-02-02 Intervertebral flexible stabilizer Expired - Lifetime EP0381588B2 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
FR8901445 1989-02-03
FR8901445A FR2642645B1 (en) 1989-02-03 1989-02-03 flexible intervertebral stabilizer as well as process and apparatus for the control of its tension before installation on the rachis

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
AT90400291T AT89713T (en) 1989-02-03 1990-02-02 Intervertebral flexible stabilizer and method and apparatus for determining or controlling its voltage before its attachment to the spine.

Publications (3)

Publication Number Publication Date
EP0381588A1 true EP0381588A1 (en) 1990-08-08
EP0381588B1 EP0381588B1 (en) 1993-05-26
EP0381588B2 true EP0381588B2 (en) 2000-05-03

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EP19900400291 Expired - Lifetime EP0381588B2 (en) 1989-02-03 1990-02-02 Intervertebral flexible stabilizer

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US (1) US5092866A (en)
EP (1) EP0381588B2 (en)
CA (1) CA2009219C (en)
DE (2) DE69001685D1 (en)
ES (1) ES2042226T5 (en)
FR (1) FR2642645B1 (en)
WO (1) WO1991016018A1 (en)

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CA2009219A1 (en) 1990-08-03 application
FR2642645B1 (en) 1992-08-14 grant
FR2642645A1 (en) 1990-08-10 application
EP0381588B1 (en) 1993-05-26 grant
CA2009219C (en) 1996-01-16 grant
EP0381588A1 (en) 1990-08-08 application
US5092866A (en) 1992-03-03 grant
DE69001685T3 (en) 2000-12-28 grant
ES2042226T3 (en) 1993-12-01 grant
WO1991016018A1 (en) 1991-10-31 application
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DE69001685D1 (en) 1993-07-01 grant
DE69001685T2 (en) 1994-01-05 grant

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